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<TITLE>Collection and destruction of the LTC facility patient generated pharmaceutical waste for Virginia</TITLE>
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<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">There has been a great deal of discussion</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> on the list</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> about the feasibility of handling the pharmaceutical waste from LTC facilities in the same manner as household generated pharmac</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">eutical waste.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> </FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">The Virginia DEQ</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">consider</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">s</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> the pharmaceutical waste</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">from the patients and residents to be excluded from</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">hazardous waste regulation, and it can be</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">collected and</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">destroyed</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> along with the other DEA collected residential pharmaceuticals</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> at the Covanta WTE incinerator in Virginia.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"></FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000"></FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">The LTC facilities must still comply with the record keeping requirements of the Board of Pharmacy and maintain a list of the medications that are</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">given to the DEA for disposal. </FONT></SPAN></P>
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<P DIR=LTR><SPAN LANG="en-us"><FONT COLOR="#000000">I am appreciative that the DEA</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> include</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">d</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> LTCs</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> with their collection event</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">, since much of the LTC residentially generated medications are disposed of through flushing. </FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000"> My focus now is to get as many of them as possible to participate in th</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">e DEA sponsored Drug Take-Back Initiative</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> as I can</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">, in addition to the 80 collection sites we have registered</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> for the April 30</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><SUP><FONT COLOR="#000000">th</FONT></SUP></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"></FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">c</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">ollection</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">event</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">to date. (Note that the Virginia DEA</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">agents</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> will be collecting t</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">he pharmaceuticals from the</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">LTC</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">facility in the week leading up to Apri</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">l 30</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><SUP><FONT COLOR="#000000">th</FONT></SUP></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> LTC staff will not be transporting them.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">)</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN></P>
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<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">Excerpts from the</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">EPA</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">waste</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">preamble and</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#000000">regulation</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> that Virginia adopted by reference</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> are provided</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> below</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">:</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> </FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
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<P DIR=LTR><SPAN LANG="en-us"><FONT COLOR="#000000">*******</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN></P>
<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">In the preamble of the UWR proposal, EPA wrote the following:</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
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Tuesday, December 2, 2008 Federal Register Volume 73, Number 232, page 73525 explains the following:</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
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<FONT COLOR="#000000">c. Long-Term Care Facilities</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
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<FONT COLOR="#000000"> Nursing homes, assisted living centers, and other long-term care facilities also may be subject to the RCRA hazardous waste generator regulations. However, many long-term care facilities may be unaware of the applicability of the RCRA hazardous waste regulations to their hazardous pharmaceutical waste. </FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN></P>
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Most long-term care facilities generate two types of hazardous pharmaceutical waste. First, the facility itself may generate hazardous wastes as a result of its central management of pharmaceuticals in its pharmacy or pharmacy-like area. These hazardous pharmaceutical wastes would be subject to the RCRA hazardous waste generator regulations since the pharmaceuticals are under the control of the facility, and, thus, the resulting wastes are generated by that facility (see 40 CFR part 262). The long-term care facilities, like other generators, are responsible for determining whether the wastes it generates are hazardous wastes subject to regulation under RCRA subtitle C. If so, the facility must then manage the wastes accordingly. Long-term care facilities face many of the same issues that health care facilities and pharmacies do in managing hazardous pharmaceutical waste, as discussed above.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
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<FONT COLOR="#000000"> </FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><FONT COLOR="#000000">Secondly, patients and residents in long-term care facilities may generate hazardous wastes. Those pharmaceuticals that are under the control of the patient or resident of the long-term care facility, when discarded, would be subject to RCRA’s household hazardous waste exclusion (40 CFR 261.4(b)(1)). Hazardous pharmaceutical wastes generated by the resident are excluded from regulation because they are considered to be derived from a household.</FONT></B></SPAN><SPAN LANG="en-us"><B></B></SPAN></P>
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<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">Regarding the facility receiving such waste, the relevant regulatory language also appears at 40 CFR 261.4(B)(1) which also states that</FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><FONT COLOR="#000000"> “</FONT></B></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">A resource recovery facility managing municipal solid waste shall not be deemed to be treating, storing, disposing of, or otherwise managing hazardous wastes for the purposes of regulation under this subtitle, if such facility:</FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><BR>
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</B></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">(i) Receives and burns only</FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><BR>
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</B></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><FONT COLOR="#000000">(A) Household waste (from single and multiple dwellings, hotels, motels, and other residential sources)</FONT></B></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000"> and</FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><BR>
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</B></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">(B) Solid waste from commercial or industrial sources that does not contain hazardous waste; and</FONT></SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B><BR>
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</B></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000000">(ii) Such facility does not accept hazardous wastes and the owner or operator of such facility has established contractual requirements or other appropriate notification or inspection procedures to assure that hazardous wastes are not received at or burned in such facility.”</FONT></SPAN></P>
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<P DIR=LTR><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Deborah L. DeBiasi</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"><B></B></SPAN><SPAN LANG="en-us"><B></B></SPAN><B><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Email: Deborah.DeBi</FONT><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">asi@deq.virginia.gov</FONT></SPAN></B><SPAN LANG="en-us"><B><I></I></B></SPAN><B><I><SPAN LANG="en-us"><FONT COLOR="#000080" FACE="Times New Roman"></FONT></SPAN></I></B><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><B><I><SPAN LANG="en-us"> <FONT COLOR="#FF0000" SIZE=2 FACE="Times New Roman">(NEW!)<BR>
</FONT></SPAN></I></B><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">WEB site address: www.deq.virginia.gov</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Virginia Department of Environmental Quality</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Office of Water Permit and Compliance Assistance Programs</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Industrial Pretreatment/Whole Effluent Toxicity (WET) Program</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">PPCPs, EDCs, and Microc</FONT><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">onstituents</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" FACE="Times New Roman"><BR>
</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">www.deq.virginia.gov/vpdes/microconstituents.html</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Mail: P.O. Box 1105, Richmond, VA 23218</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">Location: 629 E. Main Street, Richmond, VA 23219</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">PH: 804-698-4028</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><BR>
</SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" SIZE=2 FACE="Times New Roman">FAX: 804-698-4032</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#000080" FACE="Times New Roman"></FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
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